Provider Demographics
NPI:1285610832
Name:LAZZARO, DEBRA S (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:LAZZARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1234 E DUPONT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-7875
Mailing Address - Fax:260-373-9705
Practice Address - Street 1:2708 GUILFORD ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-9701
Practice Address - Country:US
Practice Address - Phone:260-355-3900
Practice Address - Fax:260-355-3079
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2013-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01041253A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000368345OtherANTHEM
IN5223OtherPHYSICIANS HEALTH PLAN
IN3937240023OtherMEDICARE DMEPOS
IN100095880Medicaid
INP00315302OtherRAILROAD MEDICARE
INP00315302OtherRAILROAD MEDICARE
IN3937240023OtherMEDICARE DMEPOS
IN100095880Medicaid